Page 17 - Ebook health insurance IC27

Sashi Publications

or more recently, directly to the hospitals through the mechanism of Third Party
Administrators.
 Over the last two decades, the standard Mediclaim product underwent a number of
revisions and modifications. Also, in recent years, particularly from private insurance
companies, there has been the availability of newer products which have included
certain innovations.
 Thus, the maximum sum insured available under Mediclaim, which used to be Rs
83,000 in 1986, became 1 lakh in 1996 and shortly thereafter, the sum insured was
increased to Rs 3 lakhs, and finally, to Rs. 5 lakhs presently.
 However, still higher sum insured is now available under other products.
Similarly, the concept of 'sub-limits' for room charges, OT, surgeon's fee etc.
which formed part of the original mediclaim product, was done away in 1996,
but has been reintroduced in newer versions of the product as a measure of
cost-control.

Innovations in health insurance

 A major innovation in the post-2000 period, is the availability of 'cashless' facility
through the agency of TPAs or through direct tie-ups of insurers with hospitals,
where the insured need not make payments to the hospitals and the same is settled
directly by the insurer (or through TPA) with the hospital.

 There has also been an increase in the maximum age at which cover can be
granted under mediclaim (subject to necessary medical examinations) which
presently stands upto 80 years in some versions- though in practice,
underwriting practices vary and acceptance rates at higher age groups are
significantly lower.

 The insurance industry also innovated and launched certain other health

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